SGN2020-00079 Ve /
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ////2/ �O
is
Request for Permit Action
f,u A k t? 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
Check(I)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE_TAKF ACTION FOR THE ITEM(S) CHECKED (1):
CANCE OID PERMIT APPLICATION.
ND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FF.FS DUE (attach case fee schedule and provide explanation below).
Permit#: SGN2020-00079
Site Address or Parcel#: I k2) 0 ..c\/'/ PAC-. HV
Project Name: GAret rs ()twice,
Subdivision Name: Lot#:
EXPLANATION: Duplicate of SGN2020-00076
Signature: p Gen Date: 12/22/2020
Print Name: Agnes in Q•r
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date 3 / Z, Byreo
Refund Processed: DateA 79 By 40 Invoice Processed: Date By
Permit Canceled: Date3 / Z/ By 0l Parcel Tag Added: Date By
I:\Building\Forms\RegPer nitAction_l2l 18.doc
1111 City of Tigard
COMMUNITY NITY DEVELOPMENT DEPARTN1 NT
TR ARD Temporary Sign Permit A e -�(
pplication ,ya
SITE INFORMATION
Address: qa 0 r'.6G me City/State: 7- r/
9--�Tenant/business name: / r 6A r� CAQ s'ce nc Zip
Zone:
APPLICANT INFORMATION
Name: r
Mailing address: cf p VJ , ., e oPre e.�
At/City/State:City/State: r-� G 2 _Phone: 32,3 3 y � p:
�r� 3t/% Ccr/ Email: S.C. 4eu'an1cT.Cp
Applicant's representative:
Phone: 303 33z 3yq Cyll Email: SC6 G
PROPERTY OWNER INF��ORMATIONSame as applicant
Name: c -ple,,,>JC &:tpp 1
Mailing address: OO/dy3Q -chi o'kw 2'trne-e City/State: '777tiori D C Zip: gJ7?2ef
Phone: .�D3 33z 3gY,6 het/ Email:
/atXa�rY�T al
SIGN INFORMATION
❑ Balloon Sign jg.Banner Sign or 0 Lawn Sign
Install date: (Valid for 10 days) Install date: f ( /Q 7/90 Q O (Valid for 30 days)
Sign dimensions: Sign dimensions: 3 ){ •d
Sign area: Sign area: Sky 535, IP&+
I am the property owner or I am eligible to initiate this application,as provided in the Tigard Community
Development Code. To the best of my knowledge, all the information provided within this application package is
completete aandd�accurate.
?
Applican rA signature* Print name Date
tr, e 6 -eft",,fe,il C. P r�-, Il/a5/20
Property o . er's signature* Print name Date
*The property owner must sign this application or submit a separate written authorization when the owner and
applicant are different people.
STAFF USE ONLY
Case No: SGN2020-00079 Application fee: $73 Received by: AL Date: 12121I2020
Approved by; A� Date: 12/2112020 Expiration date: 12/2sI2020
City ortigard • 13t2.5 SW Hall Blvd. • Tigard,Oregon 97223 • www:tigard-or.gov • 50_ IS 21"'1 • Page 1 of1
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